| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $6 | $10 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $9 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $13 | $21 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $35 | $55 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $5 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $5 | $14 | $23 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $13 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $16 | $36 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $37 | $254 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $144 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $34 | $144 | $362 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $34 | $104 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $37 | $294 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $37 | $374 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $33 | $164 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $34 | $144 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $37 | $374 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $37 | $334 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $37 | $254 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $37 | $334 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $37 | $254 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $573 | $1,121 | $1,525 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $743 | $1,886 | $2,684 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $34 | $2,744 | $5,455 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,165 | $4,299 | $6,415 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,582 | $4,870 | $7,158 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $115 | $755 | $1,395 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $319 | $989 | $1,553 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $5 | $23 | $43 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $12 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $14 | $22 |
| Cardiovascular stress test CPT 93015 • Cardiology | $110 | $156 | $183 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $14 | $59 | $85 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $132 | $181 | $226 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $17 | $176 | $425 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $48 | $214 | $553 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $96 | $335 | $529 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $36 | $266 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $149 | $268 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $264 | $605 | $923 |
| Left heart catheterization CPT 93458 • Cardiology | $325 | $1,316 | $2,641 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $447 | $1,786 | $2,901 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $109 | $275 | $511 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $101 | $218 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $43 | $103 | $215 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $183 | $269 | $404 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $3 | $30 | $48 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $5 | $99 | $193 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $33 | $61 | $116 |